Transillumination to facilitate venipuncture in children.
Transillumination to facilitate venipuncture in children.
复制标题
透照有助于儿童静脉穿刺。
DOI：
10.1213/00000539-199203000-00025
复制
发表时间：
1992
影响因子：
5.7
通讯作者：
M. Dinner
中科院分区：
文献类型：
--
作者：
M. Dinner
新生儿和婴儿的静脉穿刺通常是平稳麻醉的限速步骤。肥胖、深肤色或慢性病的儿童即使在给予血管扩张性吸入麻醉剂后，也可能对成功的静脉穿刺构成挑战。Kuhns等人（1）最初用于辅助诊断脑积水，通过皮下组织透照可视化血管解剖结构。由于大多数透照设备需要电源插座，患者可能会因长时间接触而受到热损伤。此外，它们使用起来笨重。因此，它们没有广泛应用于常规静脉穿刺。通过使用两个紧密定位的光纤灯，静脉透照器（Landry Vein Light，Applied Biotech Products，Lafayette，La.）有效地照亮皮肤下不可见的静脉，而没有热损伤的危险（图1）。静脉透照器以可调节的距离将两束强光束聚焦到皮肤内和皮肤下，以定位暗静脉结构。这些吸收了一些强光，并从软组织中突出显示。在调暗环境光之后，静脉透照器被打开，并且光纤臂在皮肤表面上扫描以可视化底层结构。最可靠的区域是前臂、手背和腕掌面，所有这些区域都容易显示其浅静脉解剖结构。在应用止血带并定位合适的静脉后，对光源臂进行微调，以最大限度地增强静脉轮廓，并使用Velcro带将仪器固定在适当位置。然后以常规方式用22号导管（婴儿）和24号导管（新生儿和早产儿）进行静脉穿刺。在早产儿中，由于皮下脂肪相对缺乏和皮肤的透明性，四肢的所有部位都容易进入。在获得便利后，静脉穿刺通常在第一次尝试时就成功了。该技术不能扩展到辅助经皮放置动脉导管。脉动动脉的光吸收不容易发生，因为它们比静脉更深更轻（2）。
Venipuncture in neonates and infants is often a ratelimiting step in the performance of a smooth anesthetic. Children who are obese, darkly pigmented, or chronically ill may pose a challenge to successful venipuncture even after the administration of a vasodilating inhaled anesthetic. Originally used as an aid to the diagnosis of hydrocephalus, Kuhns et al. (1) visualized vascular anatomy by transillumination through the subcutaneous tissue. As most transilluminating devices require electrical outlets, the patient is exposed to possible thermal injury from prolonged contact. Furthermore, they are bulky to use. Thus, they have not found widespread application for routine venipuncture. By using two closely positioned fiberoptic lights, a venous transilluminator (Landry Vein Light, Applied Biotech Products, Lafayette, La.) effectively illuminates nonvisible veins under the skin without the danger of thermal injury (Figure 1). The venous transilluminator focuses two intense light beams at an adjustable distance into and beneath the skin to localize the dark venous structures. These absorb some of the intense light and are highlighted from the soft tissues. After dimming ambient light, the venous transilluminator is turned on and the fiberoptic arms scan over the skin surface to visualize underlying structures. The most reliable areas are the forearm, the dorsum of the hand, and the volar surface of the wrist, all of which readily display their superficial venous anatomy. After tourniquet application and localization of a suitable vein, the light source arms are finely adjusted to maximize enhancement of the venous outline and the instrument is fixed in position with a Velcro strap. Venipuncture with a 22-gauge catheter for infants and a 24-gauge for newborns and prematures is then accomplished in the customary fashion. In premature infants, the relative absence of subcutaneous fat and the diaphanous nature of the skin permits easy access in all parts of the extremities. After facility is gained, venipuncture is usually successful on the first attempt. The technique cannot be extended to assist in the percutaneous placement of an arterial catheter. Light absorption from the pulsating arteries does not readily occur as they are deeper and lighter than the veins (2).